MEDICARE: MICHAEL C SMITH M.A., MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 44608	CA

General Provider Information

NPI Number	:	1720173933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C SMITH M.A., MFT

Provider Business Mailing Address
First Line	:	31 VIA DI NOLA
Second Line	:
City	:	LAGUNA NIGUEL
State	:	CA
Zip	:	92677
Country	:	US
Telephone Number	:	949-495-0026
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 DOVE ST
Second Line	:	SUITE 230
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-2433
Country	:	US
Telephone Number	:	949-338-9525
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2006
Last Update Date	:	09/20/2009

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